{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAUNDRA   K JACKSON","gend":1,"add":"3050 CEDAR LANE ROAD","city":"KENTS STORE","state":"VA","zip":"23084-9998","dob":"1971-04-07","age":"","mstatus":"","insh":"9340106*01","cliId":"","pno":"434\/591-0796","cno":"","email":"","ename":"","eno":"","pphy":"MORIKAWA, MASAHIRO MD","ppno":"434\/924-5348","pcpadd":"1221 LEE STREET FL 1","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22908,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS GROUP","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/924-8798","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.40","E11.9","L30.8","I10.","E87.6","Z11.3","G47.33","K81.0","L29.9","L50.1","S61.411A","Z91.018","Z91.09","Z88.8","R35.0","G44.229","Z01.419","Z30.42","Z87.410","L29.8","M25.561","J45.50","M25.562","G89.29","H35.411","NO DATA","H52.4","R87.610","R87.810","F17.210","K21.9","J30.89","Z12.11","Z13.5","Z12.4","K80.20","D89.0","J10.1","G44.209","E66.9","R87.615"],"date":["2021-12-14","2021-12-14","2020-05-06","2021-12-14","2021-05-10","2020-05-06","2020-05-06","2020-07-08","2021-11-29","2021-10-25","2020-05-09","2020-05-09","2020-05-09","2020-05-09","2021-05-10","2021-05-10","2021-11-08","2021-11-08","2021-11-08","2021-11-29","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-07-29","2021-07-29","2021-07-29","2021-11-08","2020-10-20","2020-11-10","2020-11-10","2020-11-10","2021-05-27","2021-07-29","2021-11-08","2020-07-07","2021-11-29","2019-03-13","2019-09-03","2019-09-03","2019-07-23"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","SALINE"," SALINE ","88","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","90","Select","Select",""],["","","KLOR-CON"," KLOR-CON ","30","Select","Select",""],["","","FLUOCINONIDE"," FLUOCINONIDE ","30","Select","Select",""],["","00168000615","TRIAMCINOLON","OIN 0.001","60","Select","Select",""],["","","MONTELUKAST"," MONTELUKAST ","30","Select","Select",""],["","","METFORMIN"," METFORMIN ","60","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","","IPRATROPIUM"," IPRATROPIUM ","30","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","HYDROCHLOROT"," HYDROCHLOROT ","30","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","8","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","MEDROXYPR","INJ 150MG\/ML","","Select","Select",""],["","","SYMBICORT","AER 160-4.5","","Select","Select",""],["","55111078401","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","59779030602","CVS","POW ","238","Select","Select",""],["","43386031208","GAVILAX","POW ","238","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","41167075142","CAPZASIN-HP","CRE 0.001","42","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}